Registration Form
Athlete’s Name:_________________ Age:_____ M/F ____ D.O.B:_______
Street Address:___________________ City__________ State____ Zip_____
Mother’s Name__________________ Home #__________Work #________
Father’s Name___________________ Home #_________ Work #________
Years of Goaltender Experience_____ Email address: ____________________
When?
September 13, 2009 – February 28, 2010
Sundays - 8:30pm – 9:25pm
Where?
Ice Works
175 Underhill Blvd.
Syosset, NY 11791
516-496-2277
How much?
Gulls and IceCats goalies receive a discount
so please call 516-677-9075 for your discount
· All 20 Sessions - $900.00 (No make-ups or refunds)
· Any 10 Sessions - $500.00 (You choose the dates in advance, make-ups available if there is room in another session)
· Pay as you go - $55.00 per session (Sessions are limited, you must pay in advance to guarantee a slot)
Each Session Includes:
• 55 Minutes of Ice Time
• Back to Basics Program
• Goalie Specific Conditioning
• Power Skating for Goalies
• Low instructor to Goalie ratio (4-1 Ratio)
PAYMENT INFORMATION
Please indicate payment method:
Check made payable to: Forward Strides
Cash (Do not send cash through the mail)
Please Send your “Circled Dates” and Registration Form
along with Payment to:
Forward Strides Goalie Training
PO Box 774
Mineola, NY 11501
516-620-4200
Waiver and Release:
Acknowledging that participation in athletics carries with it a risk of physical injury, I agree that Forward Strides Hockey, Ice Works and it’s agents and employees shall not be held liable to me or my child for any injury or damage, however caused, resulting directly from my child’s participation in this Goaltender Clinic at any time preceding, during or after the clinic is in session. I hereby discharge all persons/organizations listed above from all actions, claims and demands my child or I may have for any such injuries or damage. I also acknowledge that all pictures, video and media captured during this camp is property of Forward Strides, Inc.
X_____________________________
Parent or Guardian Printed Name
X_____________________________ _____________
Parent or Guardian Signature Date
